tracylen

I have been working in A SICU for the last 6 months. I was prior to this job a cardiac step down RN for the last 12 years and had worked about a year in ICU settings. I have had on the job training for post open hearts I was able to recover 10 open hearts in my training. I took an online class about HD monitoring. The other day I came into work and was given a hypothermia patient. The patient was cooled prior to my arrival. Another coworker experienced in hypothermia was my back up. I did not receive any formal training on the machine or protocol. The good news is, I had the patient for 2 days and he returned to complete normal functioning. I am a strong RN and always ask questions if I am not sure. Do other hospitals have training programs for this? Should I have taken the patient? Is on the job training enough?

Our K protocol is adjusted in the orders based on creatinine levels. I think you need to take in account all facts per individual patients before given electrolyte replacement. Magnesium does not have a protocol on our unit for our s/p CABG. The patients under the care of our critical docs have replacement criteria for everything. I feel that if you are ever questioning giving a dose, call the MD and ask for parameters related to creatinine level. As far as TPN goes call the pharmacist who mixes and ask about replacement. There is no wrong answer. If the patient is on diuretics than K may need to be replaced. We check one hour after infusion is complete. For HD patients, the electrolytes are usually replaced by HD Rn and MD. Hope this helps... Ask your coworkers, it is always good to get a consensus.

With the elderly it is about encouraging them to take medicine to promote pulmonary toilet. We must alleviate fears of dependence and addiction. I tell my patients if you cannot use your incentive spirometer than that is too much pain. We use Toradol for 24 -48 hours post-op or for as long as they have chest tubes. We vary our pain meds from Norco or percocet and add ultram prn. It really is about finding the right medication for the patient.